Bullet embolism within the gastrointestinal system is extremely rare. Such bullet injuries are infrequently covered in the general literature, but the surgeon should be aware of the phenomenon. Smaller caliber bullets are more common in civilian gunshot wound (GSW) events. These bullets are able to tumble through the gastrointestinal tract and cause perforation of the intestinal lumen which is small enough to be easily missed. Bullets retained in the abdominal cavity should not be dismissed as fixed and should be carefully monitored to ensure that they do not embolize within the bowel and cause occult lesions during their migration. We present a unique case wherein a bullet caused a minute perforation in the small bowel, before migrating to the distal colon, which resulted in late presentation of sepsis secondary to peritonitis. 1. Introduction Bullet emboli are rare complications of gunshot injuries [1]. The relative rarity of the condition, along with potential lack of early symptoms, often leads to significant delay in diagnosis and treatment of the problem. Consequences of such a missed injury can be devastating and prove fatal as shown in our case. The easy availability of guns in the United States, complimented by the upsurge of gun violence in a civilian urban setting, has increased the possibility of encountering bullet embolism [2]. The majority of such emboli are notoriously asymptomatic and thus can be missed on initial evaluation. Whenever initial workup fails to visualize the bullet or the entry and exit wounds do not match up, a need for detailed interrogation should be triggered in the mind of the clinician. Unexplained trajectories of bullets should raise the suspicion of bullet embolism. In this paper, we describe a rare case of gastrointestinal bullet embolism where a small-caliber bullet perforated the small bowel, migrated distally, and eventually lodged in the distal colon, which resulted in a missed injury, leading to sepsis and the demise of the patient. 2. Case Report An 18-year-old male was brought into an urban, level-one trauma center by emergency medical service after reportedly being shot in the buttocks. On arrival, the patient was awake, alert, and oriented to person, place, and time. Airway and breathing were determined to be patent and adequate. The patient’s initial vitals were T97.5°F, BP109/75, HR103, and RR20. Venous access was secured via placement of two large-bore intravenous catheters and insertion of a femoral vein triple lumen catheter. Patient was moving all four extremities upon arrival. All clothes were
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